SSRIs: Mechanisms and Effects

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Questions and Answers

Which of the following is NOT a common side effect associated with SSRIs?

Trouble sleeping

Weight gain (correct)

Nervousness

Nausea

How are SSRIs primarily metabolized and excreted in the body?

Excreted in bile and metabolized in the intestines

Directly absorbed into the bloodstream and metabolized in the kidneys

Absorbed in the stomach and excreted through perspiration

Metabolized in the liver and excreted in urine and feces (correct)

Which of the following conditions could SSRIs potentially exacerbate?

Insomnia

Asthma

Hypertension

Angle-closure glaucoma (correct)

Off-label uses for SSRIs include treatment for which of the following?

Obsessive-compulsive disorder (OCD) Signup and view all the answers

Which of the following nursing considerations is crucial before prescribing SSRIs?

Evaluate for any known allergies to SSRIs Signup and view all the answers

What is the primary action of SSRIs in the treatment of depression?

Decreasing serotonin reuptake in the brain Signup and view all the answers

Patients with which condition should exercise caution when prescribed SSRIs?

Impaired renal functions Signup and view all the answers

The half-life of SSRIs varies widely. What does this variability primarily affect?

The frequency of dosing required Signup and view all the answers

Which of the following is a common side effect of tricyclic antidepressants?

Dry mouth Signup and view all the answers

What is a significant pharmacokinetic property of tricyclic antidepressants regarding their absorption?

They reach peak levels in 2-4 hours. Signup and view all the answers

Which condition should be considered cautiously when prescribing tricyclic antidepressants?

Preexisting cardiovascular disorders Signup and view all the answers

Which of the following is NOT an off-label use for tricyclic antidepressants?

Bipolar disorder management Signup and view all the answers

What nursing consideration is essential when monitoring a patient on tricyclic antidepressants?

Assessment of heart rate and blood pressure Signup and view all the answers

Tricyclic antidepressants primarily work by affecting which of the following neurotransmitters?

Serotonin and norepinephrine Signup and view all the answers

What serious side effect of tricyclic antidepressants may require immediate medical attention?

Low blood pressure Signup and view all the answers

Which of the following side effects is most likely due to the anticholinergic effects of tricyclic antidepressants?

Blurred vision Signup and view all the answers

Which of the following patient populations should be approached with caution when prescribing antidepressants due to increased risk of adverse effects?

Patients with angle-closure glaucoma Signup and view all the answers

What is a significant interaction concern when prescribing tricyclic antidepressants (TCAs)?

Increased heart rate and hypertension when used with epinephrine Signup and view all the answers

Which condition should be assessed prior to prescribing antidepressants to avoid severe adverse reactions?

History of seizures Signup and view all the answers

What is a critical nursing consideration when starting a patient on MAOIs?

Ensure the patient has stable renal function Signup and view all the answers

What potential effect should be considered in children and young adults when prescribing antidepressants?

Risk of suicidality Signup and view all the answers

What vital sign assessment is particularly important prior to beginning treatment with antidepressants?

Vital signs, including blood pressure and heart rate Signup and view all the answers

What is a common barrier to using MAOIs in the treatment of depression?

They interact with various foods and medications Signup and view all the answers

Which of the following symptoms may indicate a shift in a manic-depressive patient initiated on antidepressants?

Heightened levels of irritability Signup and view all the answers

Study Notes

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are a common class of antidepressants that work by increasing the availability of serotonin in the brain.
Common SSRIs: Sertraline (Zoloft), Fluoxetine (Prozac, Sarafem), Citalopram (Celexa), Escitalopram (Lexapro), Paroxetine (Paxil, Pexeva, Brisdelle), Fluvoxamine (Luvox)
Common Side Effects: Nausea, sleep disturbances, nervousness, tremors, sexual problems.
Other uses: Obsessive-compulsive disorder (OCD), panic disorder, bulimia, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), hot flashes, anxiety.

How SSRIs Work

Serotonin is a brain chemical involved in mood regulation.
Depression is associated with lower levels of serotonin (and other brain chemicals).
SSRIs prevent serotonin from being reabsorbed by the brain, increasing the amount available.
SSRIs do not cause the body to produce more serotonin, they just enhance its use.
Pharmacokinetics: SSRIs are absorbed in the gastrointestinal tract, metabolized in the liver, and excreted in urine and feces. The half-life varies depending on the specific drug.

Nursing Considerations for SSRIs

Assess for Allergies: Gather history of past allergic reactions to SSRIs.
Patient History: Screen for severe depression, angle-closure glaucoma, bipolar disorder, impaired liver or kidney function, pregnancy, and breastfeeding.
Caution: Be watchful for patients with angle-closure glaucoma, urinary retention, prostate hypertrophy, recent GI/genitourinary surgery, psychiatric problems, manic-depressive disorders, history of seizures, and elderly patients. Hepatic or renal impairment can interfere with drug metabolism and excretion.

Interactions with SSRIs

Alcohol: Reduces SSRI effectiveness and increases sedation.
Tricyclic antidepressants: Can increase the effects of epinephrine, potentially leading to high blood pressure and heart rhythm problems.

Monoamine Oxidase Inhibitors (MAOIs)

Older antidepressants that work by preventing the breakdown of neurotransmitters like norepinephrine, dopamine, and serotonin.
MAOIs interact with many drugs, foods, and supplements, and can't be combined with stimulants or other antidepressants.
Nursing Considerations: Assess for allergies, impaired liver/kidney function, history of seizures/psychiatric problems/suicidal thoughts, medication interactions, and baseline vital signs.

Tricyclic Antidepressants (TCAs)

Prescribed when SSRIs or other antidepressants are ineffective.
**Common TCAs:**Amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin, imipramine (Tofranil)

Side Effects of TCAs

Common: Constipation, dry mouth, fatigue.
Serious: Low blood pressure, irregular heart rate, seizures.

How TCAs Work

TCAs increase the availability of serotonin and norepinephrine in the brain, which are thought to affect mood.
Used off-label for conditions like OCD, bedwetting, migraines, chronic pain, and panic disorder.
TCAs affect the body's autonomic nervous system, blocking histamine and causing side effects like drowsiness, blurred vision, dry mouth, constipation, and glaucoma.

Pharmacokinetics of TCAs

Well absorbed in the gastrointestinal tract, reaching peak levels within 2-4 hours.
Highly bound to plasma proteins, and easily cross the placenta and enter breast milk.

Cautions for TCAs

Patients with pre-existing cardiovascular disorders are at risk due to the cardiac stimulatory effect of the drug.
Any condition exacerbated by anticholinergic effects requires caution.

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Description

This quiz explores Selective Serotonin Reuptake Inhibitors (SSRIs), their common types, mechanisms of action, and side effects. You'll learn about how SSRIs increase serotonin availability in the brain, their uses in various disorders, and the impact they have on mood regulation. Test your knowledge on this important class of antidepressants.